目的 探究腹腔镜直肠癌全系膜切除术后吻合口漏的相关危险因素,为临床预防及治疗吻合口漏提供参考依据.方法回顾性分析2013年4月至2017年3月于承德医学院附属医院行腹腔镜直肠癌全系膜切除术328例患者的临床资料,将患者按照术后是否发生吻合口漏分为吻合口漏组与无吻合口漏组,单因素分析和多因素Logistic回归分析探究术后吻合口漏的危险因素.结果 328例患者中,发生吻合口漏28例,发生率为8.54%.单因素分析显示,术后吻合口漏与年龄、营养状况、术前血红蛋白水平、术前血清白蛋白水平、吻合口距肛门距离等因素相关(P<0.05);多因素Logistic回归分析显示,吻合口距肛门距离、营养状况、术前血红蛋白水平、术前血清白蛋白水平是腹腔镜直肠癌全系膜切除术后发生吻合口漏的主要危险因素(P<0.05).结论 为降低患者直肠癌全系膜切除术后吻合口漏的发生率,需提高患者营养状况,并控制术前血红蛋白和血清白蛋白水平,在保证切缘足够的前提下,尽可能采用高位吻合.%Objective To investigate the related risk factors of anastomotic leakage after laparoscopic total mesorec-tal excision of rectal cancer.Methods The clinical data of 328 patients in the Affiliated Hospital of Chengde Medical College,underwent total mesorectal excision of rectal cancer from Apr. 2013 to Mar. 2017 were analyzed retrospectively, the patients were divided into the fistula group and non-fistula group according to whether or not the anastomotic leakage occurred. Univariate analysis and multivariate Logistic regression analysis were used to explore the risk factors far post-operative anastomotic leakage. Results Twenty-eight cases occurred anastomotic leakage, the incidence rate was 8.54%. Univariate analysis revealed that age,nutritional status,preoperative hemoglobin,preoperative albumin,anas-tomotic distance from anus were the risk factors related to postoperative anastomotic leakage (P<0.05). Multivariate Logistic regression analysis revealed that nutritional status,preoperative hemoglobin,preoperative albumin,anastomotic distance from anus were the risk factors related to postoperative anastomotic leakage(P<0.05).Conclusion In order to reduce the incidence of anastomotic leakage after total mesorectal excision in patients with rectal cancer,we must im-prove the nutritional status of patients and control the levels of hemoglobin and albumin before the operation. As far as the cutting edge is guaranteed,the high position fits as much as possible.
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